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Please riMt or tvoe. (Form desioned for use on elite (12 -pitch) twawdtw.) <br />Form Approved. OMB No. 2059-0038 <br />EPA Form 8700-22 (Rev. 3-W Previous Mom are 0009W. ucaraar�nr cu � �+ter r r •• <br />UNIFORM HAZAIZO" <br />t engafnr H)_ Number <br />A R. Q 0 '2 ? 0 7 0 7 <br />2 Pago 1 M <br />3, Emerg W Reriporma Phone <br />242-284 <br />4, Mtanifast Traoki% Number <br />007647404 FLE <br />WAVILMWFEST <br />{405) <br />5. is-wersiors Name Addnm uenersG; n mailing eddese) <br />Love's Country 5toreg of California Love'v Country Btot*x of California #223 <br />E'_fl.' Rax 8092 1553 W. Colony Road <br />Ripon, CA 95266. <br />Rancho Santa Margarita, CA 92688 <br />Genar gars Plane: — <br />B. 7rimWorler mpenya <br />U.S. FPA ID Wombs, <br />VI:LCAR00D <br />BELSHI <br />183913 <br />tsmportar perry 6 A 10 Wimber <br />APR 06 2015 <br />8. Deo Nerds mrd $0 Address U.S. EPA ID Number <br />rrdofln ENVIRONMENTAL C A T o 8 0 0 3 3 5 2 <br />2000 -K- ALI <br />Compton, CAme02 <br />t310i sal-71�A"w'1':11"rA# c�t- <br />Pa�aPhons: <br />8b. U.3. D(?T Desabtlar (irK3r ding Proper Stipp ng Name. Hazard Cte9e, ID Number, <br />10. ContalnerE <br />11. Total <br />12. Unit <br />13. Wasoa Codes <br />No. I <br />Type J <br />HM <br />"Padun0C—uP(d-Y)) <br />Quantity <br />VA.Noi. <br />1. VW1292, t'lamaable Liquid, ie.o_s.r 3, P:iIII <br />G <br />34$ <br />X <br />(Contains Nota, t!ur•l) <br />004 <br />AM <br />010 <br />W <br />V <br />3, <br />4. <br />Dim AT <br />ard4npkglucdonaandAibDrol InbrtnMon WEAR ALL ArrRO RIATE BL' gI : 2 S 3 3 O 2 11ME *M H <br />rm". 128 FRCTEC M CLOTIaM w 'Of w <br />idtt,er, Plum. oil, Brak-c Fluid, andTAStTl -NUtt <br />itydx�t '�ltit $ T <br />owe ensw <br />5 GfNERAT0R'40P 0R'6 CERMCA110N: I haretry deader® that the cerdenta of Vs consignment ars fully end ecu mtety described above try the proper atrpptng ,,erne, and are dessfied, packaged,. <br />marked cod ia:dwo&Vwcerdedy'ard are in all respect In proper condition for transport wcordiV io appkable Iniemetlonal and national gevemmental regdaCons. Ilrexpol sNprnent and am rru Pr mart <br />59"r, 1 candy that the consents a tin cw5 g wd conform W ft terms u'the at xt*d t RA Acknowledgme nt of Cwssnt <br />10atb'fy loot Ria waste mhkalza4w statement WenitKed In 4D GFR 28227(x) (d i am a [ergo quantitygancrator) dr (b) (7 I am a small eneretnr) is true. <br />Go[rtska'iiOflef0f5 ped dime Day Yeff <br />�arxy Noothact of BEST on behalf of generxtOt <br />7 IrMghfdlal pnarisLl itrport to U.B. ElExpOft from U.S, Port of aMrylexK; <br />Ttans sexpom on oats IQs U.S.: <br />17. Trarupa>ErAda **Vnent of ReoW of Melons Is <br />S <br />raneparler 1 ft-kadrtyped Neme gti ay Year <br />/i./1 �l oz 5 <br />5T a v ,i <br />NXM <br />Transporter 2 PftrttodrTyped Name <br />18. DVnPancy <br />10a, DWorepancry Indication apace ❑ Quardttyy ❑ Typo ❑ R.eaidua ❑ Partial Re)ecrbn ❑ FJI Repolon <br />Montfest ROfererae Number <br />18b A4emaW Fa Rty (or QQnenatrr) US. EPA 10 Number <br />8 <br />Fad Ptbtst; <br />18C. SlgneAae of Plterrtele Fedk (or penen tof) ear <br />d <br />a <br />Waste Rcpdrt ManavAenl Method Codes (Is, codes for hezardoue waste dwtrnent, dispeeal, and recycling syttM%) <br />19, unixious <br />1 2. <br />20. Deeignated '"Ity Owner or Openr/x. Carkboetion of MWof i1aT W60us rnatatiatS Coveted OY U MOM 04oM as rated In item 188 <br />Pd 8ignehue MonthY Year <br />,,.m o nu rry rn nE4MUATtnIJ 4TATU tic orni IIRFf11 <br />EPA Form 8700-22 (Rev. 3-W Previous Mom are 0009W. ucaraar�nr cu � �+ter r r •• <br />